Rural health support project, Sudan : report of the mid-term evaluation

Special evaluation covers the period 10/80-1984 and is based on document review, interviews with project and Government of Sudan (GOS) officials, and site visits in the Kordofan region. An increase in A.I.D. resources is merited given the project's importance to development and drought relief efforts in Sudan. However, the GOS cannot support the project and many problems have been experienced, such as: 28- and 20-month respective contracting delays in the North and South; design problems from inadequate field work and failure to address constraints in the implementation plan (e.g., transport problems were ignored); and the lack of strategy governing implementation and sequencing of the 100-plus activities (e.g., decisionmakers in the South and in Kordofan adopted a top-down rather than the project's bottom-up orientation). In the South, implementation has been impeded by security problems (and has essentially ceased in Upper Nile and Bahr El Ghazal areas). MCH/FP institutionalization has been severely hampered by lack of national guidance, and in Kordofan by the division of preventive and curative services. The little progress made in the North in developing regional health management capabilities has come through informal on-the-job training, oriented toward service delivery rather than management; local government redivision in the South has diffused personnel and complicated administration. Supervision has been a major problem, and the project's failure to devise manpower development plans is of real concern given cost and staffing constraints. A "brain drain" among trained health workers has also handicapped the project, especially in training village health workers and developing curricula and training materials. Although little progress has been made toward community participation or development in the North, considerable efforts have been made in the South, and with good results. Also in the South, formal and informal training have contributed to good progress in drug supply and distribution; the 3 pharmacies in the North, however, are not serving rural areas, and though several studies were completed, few attempts have been made to address Kordofan's specific drug distribution problems. Detailed recommendations are provided.